1205935202 NPI number — DR. MICHAEL C EDELSTEIN MD

Table of content: DR. MICHAEL C EDELSTEIN MD (NPI 1205935202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205935202 NPI number — DR. MICHAEL C EDELSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDELSTEIN
Provider First Name:
MICHAEL
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205935202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9030 STONY POINT PKWY STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-1941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-379-9000
Provider Business Mailing Address Fax Number:
804-323-0236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9030 STONY POINT PKWY STE 450
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-379-9000
Provider Business Practice Location Address Fax Number:
804-323-0236
Provider Enumeration Date:
09/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101042502 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)